Cadaveric Fascial Sling – Fascia Lata
Why is it done?
- Stress incontinence
- A combination of stress incontinence and detrusor over-activity of which DO the lesser
- Involuntary urine leakage with any exertion, coughing or sneezing
- Risk factors
- More than 2 pregnancies, big babies, complicated deliveries, episiotomy
- Smokers
- Being overweigh
- Where Intrinsic Sphincter Deficiency has been proved due to a failed previous sling
- Failed previous incontinence procedures
How is it done?
- This procedure is done under a spinal / general anaesthetic, as decided by the anaesthetist.
- The legs will be elevated into the lithotomy position.
- A cadaveric fascia-lata will be used
- A small incision is made in the vagina.
- The sling is placed behind the pubic bone and brought to the skin above the pubic bone, through the incision.
- The sling is placed with some tension.
- The bladder will be inspected with a Cystoscopy to exclude any injuries to the bladder wall.
- The wounds are closed with dissolvable sutures and/or skin glue.
- A local anaesthetic is given for pain relief.
- A urinary catheter is placed for 24hrs.
- A vaginal plug will also be placed.
- The catheter and plug will be removed early the next morning.
- The patient’s urine output will be measured each time they urinate, and the residual will be measured. (Patients will be required to do this up to 3 times.)
- If the residual amount of urine is more than 1/3 of the total bladder capacity, the patient may have to self-catheterize, until the residual volume is acceptable.
- Prophylactic antibiotics will be given to prevent infection.
What to expect after the procedure?
- Any anaesthetic has its risks, and the anaesthetist will explain all such risks.
- Complications:
- hemorrhaging, requiring blood transfusion <1%;
- bladder perforation, requiring an open repair <1%.
- Patients will wake up with a catheter in the urethra and bladder. This will remain in the bladder for at least 24 hrs.
- Wound discomfort/pain will persist for a few days but this will subside / settle.
- You may be required to self catheterize for a week or two.
- If there is no improvement the sling may be cut, to allow spontaneous urination
- NB! Each person is unique and for this reason symptoms may vary!
What next?
- Patients will have a trial of void without catheter the next day.
- Patients will be discharged as soon as they can completely empty the bladder.
- Patients may be required to self catheterize for a week or two.
- Patients may initially suffer from urge incontinence but this will improve within the next 6 weeks.
- Allow 6 weeks for symptoms to stabilise.
- May also have abdominal pain with coughing and sneezing due to tension on rectus muscle
- There may be some blood in the urine. This can be remedied by drinking plenty of fluids until it clears.
- On discharge a prescription may be issued for patients to collect.
- Patients are to schedule a follow-up appointment in 6 weeks.
- Please direct all queries to Dr Schoeman’s rooms.
- PLEASE CONTACT THE HOPSITAL DIRECT WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.
Sacro Neuromodulation – Removal of Device
Why is it done?
- To remove a SNM device:
- Failed to alter bladder and bowel incontinence
How is this done?
- A sedation / Local Anaesthetic administered
- You will be placed prone (on your stomach) with lower back and buttocks exposed
- An incision made over the old scars.
- The lead is removed from the sacrum
- The Battery removed from its pouch.
- Wounds irrigated with Betadine and closed
What to expect
- Wound healing takes 10 days
- Keep dressings X 3-5 days
- Sutures dissolve and is not required to be removed
TURIS – Button Vaporization
Endoscopic vaporization of a benign enlarged prostate, using laser. This allows patients on anti-coagulation therapy to continue their medication with minimal risk of hemorrhage. It also allows a shorter stay in hospital.
Indications:
- Patients on anticoagulation or anti-platelet therapy
- Smaller prostate
- Where conservative management has failed.
- Patient choice
- This procedure is performed when the prostate gland is enlarged to such an extent that medication cannot relieve the urinary symptoms.
- Symptoms include:
- a weak stream,
- nightly urination frequency,
- frequent urination,
- inability to urinate,
- kidney failure due to the weak urination (obstruction),
- bladder stones,
- recurrent bladder infections.
- Medication such as Flomaxtra, Urorec, Minipress etc. should always be given as a first resort.
- Step-up therapy should have been used for prostates larger than 35-50cc with either Duodart, Avodart or Proscar
- Prostate cancer first needs to be ruled out by doing a PSA, and when indicated, with a 3T MRI scan of the prostate with an abnormal PSA with a possible prostate biopsy of any suspicious lesions.
- A TUVP can also be performed to dis-obstruct a severe prostate cancer, to allow a normal urination process
How is it done?
- You will receive a general anaesthesia, unless contra-indicated.
- A cystoscopy is performed by placing a camera in the urethra with the help of lignocaine gel
- The inside of the bladder is viewed for pathology. If any suspicious lesions are seen, a biopsy will be taken.
- A vaporization of the prostate is then started and should take 60-120 minutes depending on the size of the prostate.
- Prophylactic antibiotics will be given to prevent any infections.
- Post– operative antibiotics will be continued for 10 days.
No specimen will be obtained due to vaporization, unless PSA was suspicious and an MRI with view to prostate biopsy has excluded a prostate cancer
What can go wrong?
- Any anesthesia has its risks, and the anesthetist will explain this to you.
- No blood loss is expected.
- You will wake up with a catheter in your urethra and bladder. This will remain in the bladder overnight.
- Lower abdominal discomfort for a few days
- NB! Each person is unique and for this reason symptoms vary!
What next?
- You will spend 1 –2 nights in hospital.
- You will a trial without catheter the next day
- You will be discharged as soon as you can completely empty your bladder.
- You may initially suffer from urge incontinence and dysuria (irritable voiding) and will improve within the next 6 weeks.
- Allow for 6 weeks for stabilization of symptoms.
- There may be some blood in your urine. You can remedy this by drinking plenty of fluids until it clears.
- A ward prescription will be issued on your discharge, for your own collection at any pharmacy
- A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporization.
- Don’t hesitate to ask Jo if you have any queries
DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE
Side–effects
- Retrograde ejaculation in more than 90% of patients. Therefore, if you have not completed your family, this procedure is not for you unless absolutely necessary.
- Infertility as a result of the retrograde ejaculation.
- Stress incontinence initially for the first 6 weeks, especially in the elderly and the diabetic patients
- Patients with Multiple Sclerosis, Strokes and Parkinsons have a higher risk of incontinence and risks should be discussed and accepted prior to surgery.
- Urethral stricturing in 2-3% of patients, requiring intermittent self-dilatation.
- Regrowth of prostate lobes within 3-5 years requiring a second procedure.
- NB! Each person is unique and for this reason symptoms vary!